Dual Eligibility – Medicare and Medicaid

Dual eligibility is a term that is heard but not always understood by Medicare beneficiaries.  What it basically means to have dual eligibility is that a person qualifies for both Medicare and Medicaid.

To qualify for dual eligibility an individual must meet the requirements for both Medicare and Medicaid.  Most individuals meet the requirements for only one or the other; however there are quite a number of people who also meet Medicaid guidelines based on income and assets.

Some people qualify for Medicare and partial dual eligibility, meaning that they have Medicare coverage and can also have Medicaid coverage if they pay a very small monthly premium for it.  Others qualify for total dual eligibility, meaning that they can be covered by both Medicare and Medicaid and because their income and assets are below a certain point, they do not have to pay any Medicaid premiums.

The importance of having both Medicare and Medicaid is that they cover different things, and when an individual – especially with a low income – qualifies for both through dual coverage, they are basically covered for hospital care as well as doctor visits and medication with low or no copayments.  In addition, certain features of dual coverage may help pay your Medicare Part D coverage premiums.

If you have questions about dual coverage, how it works, whether your state provides it and whether you qualify, you can get information from your local health department.  You can also find an excellent explanation of how dual coverage works on the Centers for Medicare and Medicaid Services (CMS) website.

For more information go to the CMS website at www.cms.hhs.gov/DualEligible.

Filed under: General-Medicare

Tags: assets, dual eligibility, General-Medicare, income, medicaid, medicaid coverage, medicare coverage